Insurance form



March 18, 1941.

INSURANCE -Foml Filed my fes,y 1939 2 Sheets-Sheet 2 INVENTOR. ARTHUR JUHL ATTORNEY.

Patented Mar. 18, 1.941

"UNITED STATES (masa-zn" .This invention relates to forms for insurance policies or'the-likeand has for, its purpose the provision o f la set. of forms-comprising a continuous front and back sheet which may be readily bound into a padv and detached for use in combinationwithintermediate sheets or records and which will facilitate the preparation of an insurance policy and the accompanying records incident thereto. Y

l0 j Other and further objects of this invention and their resultant advantages will be apparent from the following :description taken in =conneetion with the drawings. in .which:' v

' Figure 1 is a perspective view of a pad of policy forms, i. e., integralfront and-back sheets con- Y -structed and arranged in. accordance with this invention;

-'Fig. 2 is a perspective` view of `a complete set of forms includinga detached integral front andd hack sheet, al1-expiration card, .daily report-and 1 operator must then lill out certain incidental invoice;

Fig. 3 is a plan view of anexpiration card and daily report or record sheet; v Fig. '4 is a planview` of an invoice sheet; and

5 is a perspective view of-a policy Ifolded for ling or delivery. In order that 'this -invention may be better understood, it is-V desirable to .briefly review the procedure now used in the preparation and issu- 'ance of an insurance policy and brieliydescribe the forms now used. The forms now employed are usually suppiiedin pads offforms and each form comprises a continuous sheet folded upon itself at its center to provide a .front and. rear sheet.'i. e., the rst,l second, third and fourth pages of the policy. The first page. as well as the second and third pages, are ruled horiz'ontally',-andparallel to tliefom and to the width of the sheet. whereas the rear page or back sheet has'an inter.

.1omediate portion thereofruled parallel to the length of the sheet, that is, perpendicular `to the fold and to the other ruling andprinting on the sheet. This latter ruled portion bears indicia of the companyissuing the policy jand rulings for the coverage and payment data; all of which appears on the outside of the policy when the completed Ypolicy is folded -in the'lisual manner for iiling or l In use,v the agent who has sold a policy sends the necessary data to the ormain omce and a blankpolicy'form isdetached from a pad of such forms andinserted ina typewritersothat 3 to provide a relativelylong-front sheet 4 and ,a shorter rear sheet 5. The upper left portionv of the front sheet l adjacent. the fold -3 Yhas 55 the proper entries may be made upon thefront l :or first page, the entries of course being made along lines parallel to the fold or the width of the page. A f'ter the necessary data hasbeen entered upon.t lle` first three pages of .the-form th'eforln is removed from the machine and 4rein- A 'Sel'td Sideways into the machille (rotated through degrees). This means that the'fornr 5 must be folded t0 permit its entry into a standard typewriter carriage or-inserted'in a special wide carriage typewriter so .that duplicate entries may be made upon the centerportion of the rear page;

on lines parallel to the length of the policy and 10 perpendicular to the fold. When' making these entries of coverage and payment data upon-the' rear page of the policy the policy form is ofcourse inserted in the typewriter in such'a. manner .that

the operator lcanllot see theentries originally 15 made on page 1 of the policy.- Accordingly, 'it is very easy for the operator to make an erroneous entry on the rear page. 'After the-rearpage-has had the necessary entries made thereon the form again is removed from the typewriter and the' '2o records such as an expiration card or sheet, as well as a 'daily or agents report and an invoice, all .of which carry -the same coverage and pay- In accordance with this invention, theidentiilfV cation, coverage and payment data uponthe rear page of the policy, the payment and coverage data uponfthe rst page of 'the Policy as 'well as upon 'theexpiration card or sheet, the daily agents report, and the bili vor.invoic`e,`ca.n all be made inone set of operations 'without removing tllepolicy form' andintermediate recordsheets from the machine. V-When it is'considered that alllarge insurance companies employ many oper- .-40

ators who donothing but llout forms and recordsall day 1ong,. the saving-.made by the use of` a set of.form's constl 'ucted and arranged in accordance with this invention will=be-`appreciated.

' 45 'canb'eseenfrom Fig. 2, the complete set jof. forms constructed and varranged itt-accordi ance. with this invention comprises Ia centinuous,

outer elongated.cover orsheet (Fig. 1) having a detachable stub portion I adapted to be -bound 505 into a flat pad 2 of'forms. The sheet is'folded pon itself-across its width andparaliel thereto-at printed thereon the name and address o f the company issuing the policy. This printing may be along lines parallel to 'the length or to the width of the sheet as may be desired. The upper right side portion of sheet 4 adjacent the fold is ruled horizontally, i. e., parallel to the fold 3 and to the width of the sheet to provide lines i for thev entry of coverage and payment data. The lower or main body portion of the first page also bears the name of the company issuing Vthe policy and is further ruled, as at-l, along lines parallel to the fold or,width of the sheet to provide a second entry of the coverage and payment data, as is usual on the first page of an insurance policy. The main body portion of the front page of the policy also contains printed conditions and agreements of the policy. Pages 2. and 3 of the folded sheet may be ruled and printed in the usual manner`along lines parallel to the fold and width of the form.

The rear sheet 5 may -also be printed to contain the data usually found on the back page of an insurance policy. This back page, as originally folded, may also be printed at one portion to lower or 'body portionf|3 comprising a daily re-.

Iand 5.

indicate the name of the company and agent issuing the policy if so desired.

The folded form comprising sheets .4 and 5, ruled and folded as described above, is particularly useful in combination with intermediate sheets or records when also ruled in accordance with this invention. According -to'thisinventiom after `the folded form is detached from the pad 2 and before the form isinserted in the typewriter, a second or intermediate sheet IU is inserted between the front and rear connected sheets 4 'I'his second sheet isscored, as at II; to provide an upper detachable stub portion I2 constituting an expiration card` or record and a port or agents record for use in the home oiiice of the company issuing the policy. The upper 1 detachable stub portion I2 is ruled and printed,

` sheets 4 and I3, and a lower portion Il ruled as at 6, in a manner identical to the upper right portion 6 of. sheet 4 of the policy forml and in' when the second entry of the coverage and payment data is made'upon sheet- 4 it will be duplicated on the lower portion I3 or report .record ofthe intermediate sheet/Il. I

A third intermediate sheet I5 `comprising an invoice or bill is also inserted in the set of forms either above or beneath the expiration card. This sheet is scored at I6 to provide an upper por-tion or bill I'I which is ruled, as at i", similarly to the rulings 6 andi* of theupper portions of as at 1b similarly to the rulings 1 and 1%. of the lower portion of sheets 4 and I3 so' that, when the'entries are made concerning the coverage and .payment data'on the first sheet 4, they are made in .triplicate on the sheet or bill I5.

From the foregoing Alt will be apparent that, by inserting the set of forms comprising the intgral sheets 4 and 5 folded along the line3 and the desired number of intermediate sheets I3 and I5, the policy bothfr'ont and back,as will be explained later, and all oilice records including -the expiration card, the dailyV report, and the invoice, maybe filled in with the necessary cover- `age and payment data in one series of operations without removingthe set of forms from the ma- It will also be obvious that, while the operator is Ventering the coverage and payment datafor the second time on the front page, the exactdata which is entered for the second time page' at the top of the rear page in a positionso that one set of coverage and payment data entries appears on the back ofthe policy form as well as on the front. The refolded policy can then be folded Ldouble at 2| and 22 (Fig. 5) in the usual manner so that what was originally the top of the front page and later the top of the back page becomes the outside of the folded policy- From the foregoing it will be seen that at least three operations are eliminated in the preparation of a completeinsurance policy and incidental records, i. e., they may all be performed together with the first operation as one set of operations.

- Furthermore, instead of removing the policy from the typewriter, reinserting it folded or unfolded in a special typewriter for the entry upon its back, the policy and incidental records are inser-ted together in the machine onlyonce and a standard width machine may be employed. Y

It will be obvious that the particular printing appears before the operator on the upper portion illustrated and certain details of arrangement e thereof may be varied without departing from the spirit and scope of this invention as defined in the appended claims.

I claim:

l. A form for ari-insurance policy or the like comprising a continuous 'sheet y:folded at its mid point having a. detachable stub portion projecting from one end adapted to he bound into a pad and said folded sheet being adapted to be folded upon itself along a line offset from said mid point to provide an integrally connected front sheet and arelatively shorter back sheet, the vfront sheet as so folded being horizontally ruled at its upper portion adjacent said new fold and parallel theretol to provide spaces for the entryof coverage and payment data, said latter ruled portion and spaces occupyinga portion equalJo one half the difference in length between said front and back sheets,` the main portion of said front sheet below said upper portion being. further ruled horizontally and parallel to said new fold and to` the width of said sheet to provide spaces for a.V second entry of -said coverage-and payment data. the

main portion of said front sheet also containing livery or filing.

2. A form for an insurance policy` or the like comprisinga continuous sheet folded upon itself to provide an integrally connected front sheet and a relatively shorter back sheetythe front sheet having spaces upon one upper portion -adjacent said fold adapted to receive indicia indieating the name of the company issuing the policy and having spaces horizontally ruled at another upper portion adjacent said fold and parallel thereto for theentry of coverage and payment data, said spaces occupying a portion equal to one half the difference in length between said front and back sheets, the main portion of said front sheet below said upper portion having further spaces ruled horizontally and parallel to said fold and to the width of said sheet to provide for a second entry of said coverage and payment data, the main portion of said sheet also having spaces containing printed conditions and 40 also becomes the outside identifying section when the policy is further folded for delivery or ling. t

3. A set of forms for insurance policies or the like comprising a continuous sheet folded upon itself to provide an integrallyconnected front sheet and a relatively shorter back sheet, the front sheet having spaces horizontally ruled at its upper portion adjacent said fold and parallel thereto for the entry of coverage and payment data, said ruled portions and yspaces occupying a portion equal to one half the difference between the length of said front and back sheets, the main portion of said front sheet below said upper portion having additional spaces ruled horizontally and parallel to said fold and to the width of said y -sheet toprovide for a second entry of said coverage and payment data, the main portion of said front sheet also containing spaces having printed conditions and stipulations of the policy,

said back sheet having spaces printed and ruled parallel to said i'old for the entry of policy information; and an intermediate sheet disposed betweenthe connected front and back sheets of said form, said intermediate sheet having a detachable upper portion having spaces equal in size and ruled similarly to the upper portion of 'said front sheet for the simultaneous duplicate entry of coverage and `payment data andthe main portion of said intermediate sheet also 'having spaces ruled horizontally similarly to the -I side identifying section when the policy is further 40 folded for delivery or filing.

. ARTHUR JUHL. 

